Penile implants for treating ED — a long-term solution

A penile implant is a long-term solution for men with erectile dysfunction (ED) who decide that other treatment options (pills, injections, urethral suppositories, and vacuum devices) are not creating a satisfactory erection. Success with treatment options vary because each man is unique and there are a variety of causes of erectile dysfunction. ED becomes very common in men over 40 years old. As a urologist who treats men with ED, I think it is very important for men to know all of their options for the treatment of their ED —including the penile implant — at the outset of treatment. Many men become discouraged when pills don’t work and don’t pursue further treatment for erectile dysfunction because they don’t know all of their options, including a penile prosthesis procedure.

I tell my patients that fluid creates erections. In men without ED, this fluid is blood that fills the penis and makes it firm. The penile prosthesis functions using fluid to create a firm erection in men whose own blood vessels cannot supply enough blood to create a firm erection. Two cylinders are implanted into the penis; the cylinders can be filled with fluid, or saline, which is essentially salt water. The device can consist of two or three pieces but the idea is the same with either configuration. The man has a pump in his scrotum. The pump is squeezed to fill the penis with fluid. A button on the pump is squeezed to drain the cylinders when an erection is no longer desired. Operation mimics the stages of an erection. There is a third type of penile prosthesis, the malleable penile implant. The malleable penile prosthesis mechanism does not use fluid but keeps the penis firm and can be bent up or down depending if that man wants to be erect.

The benefits of the procedure to place a penile implant are clear. The man can have an erection any time he wants without the need to depend on something outside of his body such as pills or injections. A penile prosthesis implant increases his confidence and allows for greater spontaneity surrounding sex. I tell my patients you don’t have to worry if you packed your supplies when you want to have sex while traveling. It also doesn’t expose patients to the same side effects that medications or external devices can present. Pills can cause side effects such as headaches, visual changes, and stomach upset. Injections, urethral suppositories, and pumps can be painful to use. Once a patient has healed from the penile prosthesis procedure to place an implant, he does not have to worry about side effects or discomfort in association with sex. The procedure truly restores a man’s function in a way other treatments cannot.
 

Issues related to costs of a penile implant should be addressed before the procedure so that each patient understands what the costs will be. Medicare and many other insurers cover the surgery to place a penile prosthesis. The patient’s urologist’s office can assist in confirming coverage and determining what out-of-pocket costs the man may have.

The success rates with these devices are very high. Patients who have their prosthesis placed by a surgeon experienced with this procedure often have better outcomes (lower rates of infection or poor positioning of the device). Satisfaction is higher with penile prostheses compared to all other treatments for ED. Patient and partner satisfaction exceeds 95% after the procedure.¹

Key to satisfaction is the patient having a good understanding of what the penile implant is designed to do. It is not designed to regain length that may be lost due to diseases such as Peyronie’s or long-standing ED. It will, however, create a dependable, on-demand erection any time the man wants it. Urologists are fortunate to have such a fantastic treatment for ED.